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Kevin Cullen

Preexisting conditional

By Kevin Cullen
Globe Columnist / October 26, 2009

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Art and Sallie Cote have watched from the couch in their Salem apartment as lawmakers in Washington debate health care, and they have one question: What planet are these people on?

“I listen to these politicians who say we don’t have to change the status quo, and I’m thinking, have they ever spent one day worrying about their health insurance?’’ Sallie Cote said. “I can’t understand everybody saying ‘don’t fix what’s not broken.’ Because it is broken. All these people who have so much confidence in the insurance companies must have never had to deal with them, because Art and I did, and I can tell you right now, we don’t have that much confidence in the insurance companies.’’

The Cotes have come out the other end, and they’re fine. They are now in their 70s and have Medicare, the ultimate public option. But how they spent their middle age, playing a game of chance that millions of Americans play every day, one step ahead of disaster, is a prescription for change.

When Art Cote was 54 years old, the company where he worked for 33 years went belly up, and so did his and his wife’s health insurance. Sallie’s secretarial jobs provided only a paycheck.

Art’s pension disappeared with the company, so they sold their house in Marblehead. They were too young for Medicare, and the proceeds of their house sale made them not poor enough for assistance. They tried to buy private insurance. Every insurance company they called said: Sure, we’d love to have you as a customer, and we’ll cover everything except your preexisting conditions.

“What’s the point of having health insurance if it doesn’t cover what’s most likely going to put you in the hospital?’’ Sallie asks.

Their preexisting conditions were relatively minor. In Art’s case, it was a treatable heart condition which requires his heartbeat having to be zapped back into a normal rhythm once in a while. For Sallie, it was a gynecological issue that eventually resolved itself when she went through menopause.

“We’d call the insurance agents, and once they heard about preexisting conditions, they didn’t call us back,’’ Sallie said.

One agent, however, took pity on them and gave them some advice that probably wasn’t approved by the home office.

“He told us that even if we got coverage, anything that happened to us, the insurance company would say it was because of the preexisting condition and we’d be stuck with the bill. I thanked him for his honesty,’’ Art Cote said.

So they paid out of pocket for years. One year, the total was $10,000. Another, it was $13,000.

One of Art’s procedures required an overnight hospitalization and left them with a bill of $3,400.

“We told the woman at the hospital, ‘We don’t have insurance.’ And she said, ‘Is $800 reasonable?’ And we said sure. She said, ‘We’ll charge you like you’re on Medicare.’ But then you’re wondering, how do they arrive at the costs of these things?’’

Over all those years, Art and Sallie Cote had to cut corners on their health and rationed something that shouldn’t be rationed: their peace of mind.

“I would get a mammogram, knowing that if the doctors found anything I wouldn’t be able to afford the treatment,’’ Sallie says. “We spent our middle age counting the days until we were 65 and would be covered by Medicare.’’

They made it, and now they watch a health care debate that has become little more than a partisan food fight. They wonder why more attention is paid to Balloon Boy and his nutty parents than to something so fundamental as health care.

“What I’m always struck by is how few people who are taking part in this so-called debate have actually experienced anything like Art and I did,’’ Sallie Cote said. “They seem to have other agendas.

“I watched all these old people screaming at those town meetings that they didn’t want the government involved in their health care, and they’re all on Medicare.’’

Kevin Cullen is a Globe columnist. He can be reached at cullen@globe.com.

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